Dr. MJ Bazos MD,
Stool Soiling or
When Your Toddler
Won't Use the Toilet
Why do some children who are already
potty-trained still have bowel movements in their pants?
Sometimes children who have already been
potty-trained accidentally "soil," or have a bowel movement, in their pants.
Soiling is usually caused by constipation (can't have a bowel movement easily).
Children who are constipated may have one or more of these signs:
- Very small, hard, dry or rock-like stools
- Blood-streaked stools
- Pain or crying during bowel movements
- Stomach pains
- Crankiness or restlessness during the day
- Loss of appetite
If your child is soiling and
shows signs of constipation, call your family doctor.
But some children who've already learned to use
the toilet to urinate during the day still soil their pants. These children
aren't constipated and don't seem to have any medical problems. They haven't yet
learned about using the toilet for bowel movements. They usually soil their
diapers or pants almost every day and have normal bowel
Why does my child seem to have
trouble using the toilet for bowel movements?
A child who gets constipated often or has bowel
movements that hurt may resist toilet training. Your child could be scared of
being alone in the bathroom, or scared of the toilet. Some children use soiling
as a way to control things or to get extra attention. Others just don't want to
Is this just a
It's possible that your child is going through
"a phase." Your child may not have the skills yet to use the toilet. But, if
your child keeps soiling after about three months of being able to use the
toilet to urinate, it's probably time for him or her to learn to use the toilet
for bowel movements. If other daily routines, such as getting dressed, picking
up toys or going to bed are a problem, it may be best to get help for those
problems before you try toilet training. Your doctor can offer advice and tell
you who to call for help.
How should I start toilet training
my child for bowel movements?
Here are 6 steps to help you teach your
1. Make a toilet diary.
Keep a "diary" showing when, where and
what kind of bowel movements your child has. It will help you and your doctor
see patterns in your child's bathroom habits. Try to keep a toilet diary for at
least one week before going on to step 2. If your child is in day care, ask the
teacher to help you look for patterns in your child's toilet behavior. At the
end of this handout there's a sample toilet diary you can use to help
2. Teach your child to sit on the toilet.
At first, you and your child can play in
the bathroom to show that the bathroom is not a bad place. After a few weeks,
your child should start sitting on the toilet (with pants on) for a few minutes
at a time. Your child may need a foot stool and favorite books, dolls or small
toys during bathroom time.
Read, talk to and play with your child when
you're in the bathroom together. Don't expect--or ask--your child to have a
bowel movement on the toilet yet. Remember, he or she is still getting used to
the idea of sitting on a toilet. Start with a very short amount of time (about
30 seconds) and slowly work up to 5 minutes. A kitchen timer can be the signal
for the end of "bathroom fun." Move to step 3 once your child is sitting on the
toilet 3 to 5 times a day, for 5 minutes each time.
3. Make sure your child's bowel movements are
soft and well-formed.
Your child may
decide to stop having bowel movements for a while after "graduating" from
diapers (see step 4). To avoid this problem, make sure your child is having
soft, well-formed bowel movements. It helps if you give your child less dairy
food and more high-fiber foods. If your doctor says it's OK, you may be able to
give your child fiber supplements or laxatives for a short time. Ask your family
doctor about diet changes.
At first, your child may have more soiling
accidents. Have your child help clean up messes, but don't yell or punish your
child for soiling. Being angry with your child when he or she soils only makes
toilet training harder. Try to stay calm and relaxed when your child soils, so
he or she won't feel bad.
4. 'Graduate' your child from diapers.
Have a small family "graduation" party.
Tell your child that he or she is now a "big boy" or a "big girl" and won't be
wearing diapers anymore in the daytime. It's OK to use diapers at night for a
while if your child still wets the bed. Don't use diapers for special times like
shopping trips. This sends the wrong message. Choose a low-stress time to start
this step of toilet training.
5. Have set times for sitting on the
Once your child is having
healthy bowel movements and is used to sitting on the toilet, start having him
or her sit on the toilet at regular times during the day. Time the sits to start
about 10 to 20 minutes after each meal and during times when your child usually
has a bowel movement. You'll be able to tell these times from the toileting
diary. Your child should sit on the toilet at least 3 to 5 times per day, for
about 5 minutes each time.
6. Reward bowel movements in the toilet.
The first time your child has a bowel
movement in the toilet, give him or her a reward. Good rewards are stars on a
chart or fun activities. At first, give a reward after every bowel movement in
the toilet. Later, give the reward after every few bowel movements. Pretty soon
your child will be trained. Then you can stop giving rewards.
Next, teach your child to know when it's time to
go to the toilet. Teach your child to tell you, instead of waiting for you to
ask. Young children should tell a parent before they use the bathroom, in case
they need help.
When should I call my
If your child doesn't have a bowel movement for
3 or 4 days in a row, you should call your doctor. He or she will suggest
something to give your child to prevent constipation. After you've done this,
you should go right back to the step you were on before and keep
BMT=bowel movement in toilet
BMP=bowel movement in pants
BMB=bowel movement in bed
UT=urinates in toilet
UP=urinates in pants
UB=urinates in bed
Directions: When your child has a bowel
movement or urinates:
- Put day of week and date in the first column.
- Put time of day in "Time" column.
- Add the code to the "Time" column.
- Continue each day.